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Hip Ultrasound – Examination & Hip Dysplasia

Hip ultrasound is an imaging method used to assess the hip joint, especially in newborns. It detects conditions such as hip dysplasia early, without radiation or pain.

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Things worth knowing about "Hip ultrasound"

Hip ultrasound is an imaging method used to assess the hip joint, especially in newborns. It detects conditions such as hip dysplasia early, without radiation or pain.

What is a Hip Ultrasound?

Hip ultrasound (also called hip sonography) is a diagnostic imaging technique that uses high-frequency sound waves to visualise the structures of the hip joint. The procedure is painless, radiation-free, and suitable for patients of all ages. It is most widely known as a newborn screening examination, used to detect developmental disorders such as hip dysplasia at an early stage.

When is Hip Ultrasound Performed?

Hip ultrasound is used in a variety of clinical settings:

Newborn screening: In many countries, including Germany, hip ultrasound is a routine part of early infant check-ups (in Germany: U3 examination, performed between the 4th and 6th week of life). It is used to rule out or detect hip dysplasia or hip dislocation.
Infants and children: When clinical signs such as restricted leg abduction or an abnormal newborn screening result are present.
Adults: To assess soft tissue structures such as bursae (bursitis), tendons, muscles, or fluid collections within the hip joint.
Pregnancy: Occasionally used for prenatal assessment when fetal hip malformation is suspected.

How Does Hip Ultrasound Work?

During the examination, a transducer (probe) is placed on the skin over the hip area, which is first covered with a water-based gel to improve sound transmission. The probe emits high-frequency sound waves that are reflected differently by various tissue structures. These reflections are displayed as a real-time image on a monitor. The procedure typically takes only a few minutes and causes no discomfort.

Assessment According to the Graf Method

In newborns and infants, the hip is commonly evaluated using the Graf method (developed by Prof. Reinhard Graf). This technique involves measuring specific angles within the ultrasound image:

Alpha angle (α): Reflects the bony coverage of the femoral head. A value above 60° is considered normal.
Beta angle (β): Represents the cartilaginous portion of the acetabular roof.

Based on these measurements, hips are classified into Graf types (Type I to IV), ranging from normal to severely pathological:

Type I: Mature, well-developed hip joint. No treatment required.
Type II: Physiologically immature or mildly dysplastic hip. Monitoring or treatment may be needed.
Type III and IV: Decentred hip joint. Treatment is necessary (e.g., abduction splint, Pavlik harness, or surgery).

Advantages of Hip Ultrasound

No ionising radiation – making it ideal for infants and pregnant women.
Painless and quick procedure.
Real-time visualisation of soft tissue structures including cartilage, tendons, and bursae.
Early detection of malformations enables timely and effective treatment.

Limitations of the Method

Hip ultrasound does have limitations. In older children and adults, increasing ossification of the joint reduces image quality, as sound waves cannot pass through bone. In such cases, complementary imaging such as X-ray, CT, or MRI may be required for a comprehensive assessment.

References

Graf, R. - Sonography of the Infant Hip and Its Therapeutic Implications. 7th edition, Thieme Publishers, 2019.
Shorter, D. et al. - Universal or selective newborn hip screening for developmental dysplasia of the hip: a systematic review. BMJ, 2013.
Castillo, M. et al. - Pediatric Hip Ultrasound: A Practical Guide. Pediatric Radiology, 2021.

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